Puttenstein, R. (Reinate) (2018) ‘Effecten van op-maat gemaakte interventie- en implementatieplannen op de reductie van onjuist psychofarmacagebruik bij ouderen met dementie in Nederlandse verpleeghuizen’. thesis, Medicine.
Full text available on request.Abstract
Introduction: In the Netherlands, neuropsychiatric symptoms occur in about 80% of the residents with dementia of Dutch nursing homes and they are often a reason to prescribe psychotropic drugs. However, there is evidence that psychotropic drugs have limited efficacy and considerable side effects. Nevertheless, psychotropic drugs are prescribed completely correct in only 10% of psychotropic drug users with dementia in the Netherlands. This means that in many cases, psychotropic drugs aren’t correctly indicated or evaluated. Previous studies on complex interventions at department level show small effects. Presumably, this is due to suboptimal implementation and because of the interventions don’t fit with problems that are experienced in nursing homes. That is why the RID-study (reduction of inappropriate psychotropic drug use) has been set up. This study uses the PAR-method(Participatory Action Research) in order to match the interventions with the nursing homes and improve the implementation through coaching. The aim of this study is to investigate the effects of tailored intervention and implementation plans, aimed at the reduction of inappropriate psychotropic drugs-use in residents with dementia in Dutch nursing homes. Materials and methods: The duration of the RID-study was sixteen months, which were divided in two periods of eight months. Sixteen Dutch nursing homes were divided into two groups: one intervention group with an intervention duration of sixteen months, and one control group with eight months of usual care and an intervention duration of eight months. Measurements took place at 0, 8 and 16 months. In this study, the degree of inappropriate psychotropic drug use, using the APID measuring instrument, and the percentage of psychotropic drug use were examined at the measurements after 0 and 8 months. According to the PAR-method, there was a cyclic approach of planning, acting, observing and reflecting. Each nursing home composed a multidisciplinary project team and, under the guidance of an external coach, they wrote an intervention and implementation plan. The plans matched the problems that staff experienced in dealing with problem behavior. Based on a process evaluation, consisting of a questionnaire and a semi-structured interview for both the coach and internal project leader, information about the interventions is collected, together with the degree of implementation and implementation influencing factors. Results: One of the nursing homes has started prescribing psychotropic drugs significantly more appropriate and none of the nursing homes prescribed significantly fewer psychotropic drugs at measurement 2. The most chosen interventions were: education about psychotropic drugs, residents’ meeting/case review for potential reduce of psychotropic drugs and/or to discuss problem behavior, involving family in the care process, education about problem behavior, using a systematic approach to problem behavior, improving psychotropic drugs reporting and using residents’ life stories. Commitment of the project team and especially the doctors is essential for the implementation of interventions and absence of this commitment is seen as an important barrier to implementation. Also, self-managing teams and staff turnovers are important barriers to implementation of interventions. Conclusion: Tailored interventions don’t show obvious positive effects, although some nursing homes show small positive differences in the use of psychotropic drugs. Further research should focus at going through the PAR-cycle repeatedly, whereby barriers for implementation will be opposed actively.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: Prof. Dr. S.U. Zuidema, Hoogleraar Oud and Universitair Medisch Centrum Groningen; Afdeling Huisartsgen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1842 |
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